The Effects of Thoracic Flexibility Exercise on Pain, Range of Motion, Spinal Alignment, Proprioception, and Neck Disability Index in Neck Pain Patients with Forward Head Posture: A Randomized Controlled Trial.

Background and Objectives: Thoracic dysfunction may contribute to neck pain, restricted mobility, and altered spinal alignment in individuals with forward head posture (FHP). This study compared thoracic flexibility exercise (TFE) with cervical stabilization exercise (CSE) in terms of their effects on pain, range of motion (ROM), spinal alignment, proprioception, and neck-related disability in patients with chronic neck pain and FHP. Materials and Methods: Twenty-four participants were randomly assigned to either the TFE group (n = 12) or the CSE group (n = 12). Both groups performed their assigned intervention once per day, three days per week, for four weeks. The outcome measures included pain intensity, cervical and thoracic ROM, craniovertebral angle (CVA), cranio-rotation angle (CRA), thoracic kyphosis angle (TKA), proprioception, and the Neck Disability Index (NDI). Paired t-tests were used for within-group comparisons, and independent t-tests were used to compare change scores between groups. The Benjamini-Hochberg false discovery rate (FDR) procedure was applied to the between-group comparisons to account for multiple testing. Results: The TFE group showed significant improvements in all outcome measures following the intervention (p < 0.001). The CSE group showed significant improvements in pain, cervical flexion, extension, and right and left rotation, CVA, CRA, proprioception during extension and right and left rotation, and NDI (p < 0.05); however, no significant improvements were observed in thoracic ROM, TKA, or proprioception during flexion (p > 0.05). After FDR correction, between-group comparisons demonstrated significantly greater improvements in the TFE group than in the CSE group across all outcome measures (q < 0.05). Conclusions: TFE may be more effective than CSE in improving pain, ROM, spinal alignment, proprioception, and neck-related disability in patients with neck pain and FHP.